International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction

Background

The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.

Methods

The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.

Results

A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.

Conclusion

The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.

Paediatric hearing screening in the community: a comparison of outcomes from transient evoked and distortion product otoacoustic emission measures

The present study aimed to compare TEOAE screening outcomes based on different pass/fail criteria and the outcomes from TEOAE and DPOAE measures in children. For the purpose of the study, the subjects were divided into two age groups: group 1 (n = 36; mean age 2.7 months, SD 1.2), and group 2 (n = 29; mean age 37.5 months, SD 16.3). Results indicated that the agreement of screening outcomes between pass/fail criteria for the TEOAE measure and between TEOAE and DPOAE measures was significantly lower for the younger group than for the older group. The greater variability in the younger age group could be partly attributed to the higher physiological noise produced by young infants. Irrespective of the pass/fail criteria used, the findings of the present study suggest that the OAE outcomes for children with weak OAEs or OAEs obscured by excessive noise were most variable.

The effect of high-pass filtering on TEOAE in 2-month-old infants

The aim of the present study was to investigate the effect of high-pass filtering on TEOAE obtained from 2-month-old infants as a function of filter cut-off frequency, activity states and pass/fail status of infants. Two experiments were performed. In Experiment 1, 100 2-month-old infants (200 ears) in five activity states (asleep, awake but peaceful, sucking a pacifier, feeding, restless) were tested by use of TEOAE technology. Five different filter conditions were applied to the TEOAE responses post hoc. The filter conditions were set at 781 Hz (default setting), 1.0, 1.2, 1.4 and 1.6 kHz. Results from this experiment showed that TEOAE parameters such as whole-wave reproducibility (WR) and signal-to-noise ratio (SNR) at 0.8 kHz and 1.6 kHz, changed as a function of the cut-off frequency. The findings suggest that the 1.6 kHz and 1.2 kHz filter conditions are optimal for WR and SNR pass/fail criteria, respectively. Although all infant recordings appeared to benefit from the filtering, infants in the noisy states seemed to benefit the most. In Experiment 2, the high-pass filtering technique was applied to 23 infants (35 ears) who apparently failed the TEOAE tests on initial screening but were subsequently awarded a pass status based on the results from a follow-up auditory brainstem response (ABR) assessment. The findings showed a significant decrease in noise contamination of the TEOAE with a corresponding significant increase in WR. With high-pass filtering at 1.6 kHz, 21/35 ears could be reclassified into the pass category.

Tidal breathing parameters in young children: comparison of measurement by respiratory inductance plethysmography to a facemask pneumotachograph system

The ratio of expiratory time at tidal peak flow to total expiratory time (t(ptef)/t(e)) correlates with conventional measures of airway obstruction. It is usually assessed using a facemask and pneumotachograph system which may be poorly tolerated in young children and hence limits the usefulness of this technique. We therefore determined in young asthmatic children the accuracy of t(ptef)/t(e), using an uncalibrated respiratory inductance plethysmograph (RIP), and compared the results with those from a facemask-pneumotachograph system. We also assessed whether age influenced the agreement between measurements using the two devices. Forty-seven children aged between 1 month and 12 years were recruited: 39 were inpatients recovering from an acute wheezy episode, and 8 were recruited from the asthma clinic. All were receiving bronchodilators. Tidal breathing parameters t(ptef)/t(e), the duty cycle (t(i)/t(tot)), and respiratory rate were initially measured using the Respitrace alone and then simultaneously with both the Respitrace and the facemask-pneumotachograph system. Eight children did not tolerate the facemask, and in two others it was impossible to analyze the Respitrace trace due to artefacts. In the remaining 37 children, the reliability coefficients and coefficients of variation of the two techniques were similar. Similar values of t(i)/t(tot) and respiratory rate were obtained using the two devices. The mean t(ptef)/t(e) obtained using the Respitrace was lower than with the facemask-pneumotachograph system (P < 0.01), although this was age group-dependent (P < 0.05), as the difference was less apparent in the 1 to 2-year-old children than in other age groups. Application of the facemask-pneumotachograph system did not significantly influence the results obtained using the Respitrace. We conclude that uncalibrated respiratory inductance plethysmography can measure tidal breathing parameters as reliably as a facemask-pneumotachograph system in young asthmatic children, and is better tolerated than the pneumotachograph system. The results obtained using the two devices are not interchangeable.

Driving cycles for measuring passenger car emissions on roads with traffic calming measures

Although local authorities in the UK need to be aware of any air quality impacts resulting from their traffic calming operations, there is little information relating to the effects of different traffic calming measures. The effects on air quality on this scale are complex, and so TRL is providing guidance by developing performance indices for different measures based on their effects on vehicle emissions. The emissions indices for passenger cars are based on tests conducted on a chassis dynamometer, and this paper describes the development of the methodology for constructing the driving cycles to be used. The technique involves the measurement of the speed profiles of a large number of vehicles using a roadside LIDAR system, and the determination of typical gear selections using three-instrumented cars.

Transient evoked otoacoustic emissions in two-month-old infants: a normative study

Researchers have recently reported the effects of age, sex, ear asymmetry, and subject's activity status on transient evoked otoacoustic emissions (TEOAEs). The present study aimed to expand upon such reports by describing the characteristics of TEOAE spectra obtained from a cohort of 607 two-month-old infants in community child health clinics. Results indicated significant sex, ear and activity state effects on the signal:noise ratio, response, whole wave and band reproducibility values. These findings suggest the need for TEOAE normative data to be expressed as a function of sex, ear, and activity state of infants. These characteristics of TEOAE spectra may shape future investigations into appropriate pass fail criteria for two-month-old infants.

Feasibility of community-based hearing screening using transient evoked otoacoustic emissions

This study investigated the feasibility of obtaining transient evoked otoacoustic emissions for hearing screening purposes from infants and children at seven child health clinics. Factors affecting the outcomes of the community hearing screening program were examined. The subject group comprised 2305 children aged two weeks to 11 y 11 mon. Many children were attending the clinics for initial immunisation at two months of age. While there were no exclusion criteria for the 1305 young infants tested who were in this category, all other children were screened only upon receipt of a referral from clinic nurses. Results indicated that 182 children (7.9%) did not complete the screening for both ears within the time constraint (usually 15 min) of a child health clinic visit. Three hundred and sixty-two children (15.7%) failed the first screening. Of the 226 children who returned for a second screening test, separated from the first by at least two weeks, 121 children failed. With parents' consent, 107 children (4.6% of all participants) were referred for diagnostic or medical assessment. Subsequently, 77 out of 94 children who received audiological or medical assessment were found to have some degree of hearing impairment. The majority of positive screening results were associated with middle ear disorder. The results suggest that TEOAE screening has potential as a technique in the community health setting but improvements in instrumentation are required to reduce 'could not test' cases and to separate probable conductive hearing loss from cases likely to have other disorders.

Infant hearing screening: a comparison of two techniques

Hearing screening programs for Australian children are known to have poor coverage in many areas. In addition, only a minority of children are screened for hearing loss before 2 years of age. However, early detection of hearing loss and early treatment are generally considered very important to successful rehabilitation outcomes. Traditional methods of screening infants have limitations with their accuracy in detecting children with hearing loss. This study compared the results obtained with a traditional questionnaire approach to screening and a newer objective technique involving otoacoustic emission measures. Poor correlation was found between pass rates for the two techniques, suggesting that the questionnaire approach is not an accurate screening method for detecting infant hearing loss. With further development, otoacoustic emission testing holds promise as an objective alternative hearing screening procedure.

Transient evoked otoacoustic emissions in infants: effects of gender, ear asymmetry and activity status

This study examined the effects of gender, ear asymmetry and activity status of infants on various measures of transient evoked otoacoustic emission (TEOAE), including signal-to-noise ratio (SNR) and reproducibility of emissions, using TEOAE as a mass screening procedure in a community health setting. Five hundred and sixty-eight infants were screened for hearing at two months of age, before immunization. The ILO88 Otodynamic Analyzer Quickscreen program was used for all testing with pass/fail criteria similar to those used in the Rhode Island hearing assessment project. The results indicated a significant difference in SNR across sex, with females showing a higher mean SNR. The right ear was found to have higher values in 'reproducibility' and 'response level' than the left ear. A significant difference in SNR across activity states was also evident. Implications from these findings, as applied to community-based screening programs, are discussed.

Argon ion laser atheroablation: influence of plaque composition

This study quantifies the relationship between exposure time, depth of penetration, extent of lateral and deep cellular disruption (LCD and DCD, respectively), and the intrinsic resistance of different grades of atherosclerotic plaque. Argon ion laser atheroablation (AILA) was accomplished via a 200-micro quartz fiber using 2.0 and 5.0 watts of power for standard exposure times in fibrofatty, calcified, and complicated cadaveric human aortic plaque. Gross and histologic analyses revealed the following information: 1. The extent of LCD and DCD increased minimally with longer exposure times, irrespective of plaque grade or laser wattage. 2. At both levels of power, the average rate penetration was slower in calcified than in fibrofatty plaque (p<0.01). 3. Increasingly the laser power increased the rate of penetration per unit of energy. 4. The rate of penetration was quite variable, even among plaques of the same grade, depending on the calcium composition of each sample. In summary, AILA was found to be significantly affected by plaque composition, whereas energy efficiency and accuracy could be maximized by increasing the laser wattage.

An investigation of operating theatre staff exposed to humidifier fever antigens

Sixty staff working in a hospital operating theatre, where a case of humidifier fever had been identified, were studied together with 49 subjects working in other parts of the hospital. They each had a blood test for serology, a skin test, and a chest radiograph and completed a questionnaire. The theatre staff also had pulmonary function tests. The theatre humidifier was found to contain several organisms including amoebae and antigens cross-reacting highly with those implicated in previous outbreaks of humidifier fever. Of the 60 exposed subjects, 25 had developed antibodies, nine had probable symptoms of humidifier fever, and six possible symptoms. There was a strong association between symptoms and antibodies (p = 6 x 10(-5) by Fisher's exact test). The development of antibodies was also related to duration of exposure in the theatre (p less than 0.01 by X2 test for trend) and inversely to smoking (p = 0.0073 by Fisher's exact test) but not to history of atopy. Because of the presence of antigens and because certain biocides added were ineffective in controlling antigenic build-up the humidifier was switched off. Eight months later specific IgG levels in the theatre staff sera, estimated by an enzyme-linked immunosorbent assay technique, had fallen on average by 25%. Inhalation challenge with humidifier water was performed in eight subjects. Four subjects reacted to the challenge, including both those with antibodies and previous symptoms.

Salicylate sensitivity in children reported to respond to salicylate exclusion

Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a double-blind, cross-over trial with ascorbic acid as a placebo. The children were tested within three hours of ingestion of either the experimental or placebo tablet with a battery of psychological and neurological tests, and were rated by a parent on an enlarged Conners' Parent-Teacher Questionnaire for four days after the ingestion of the tablet. It was found that significance was reached in tests of general cognitive capacity, line walking and the "finger-to-nose" tests, as well as increased disturbance in sleep patterns in these children.

Transient hyperphosphatasemia of infancy--an insufficiently recognized syndrome

Spectacular transient increases in serum alkaline phosphatase were observed in five infants in the absence of demonstrable pathology.

Transient hyperphosphatasemia of infancy--an insufficiently recognized syndrome

Spectacular transient increases in serum alkaline phosphatase were observed in five infants in the absence of demonstrable pathology.

Further modifications in the children's jejunal biopsy capsule

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